10 Grief Counseling Therapy Techniques & Interventions

Grieving is usually recognized as both a process and a state.

Those in the midst of it typically pass from a period of life-altering loss to one of relative stability (Neimeyer, 2015).

The journey is not an easy one. Close relationships are what we cherish the most, forming the heart of what we care about. When they end, especially when abruptly or unexpectedly, the pain can be profound (Neimeyer, 2015).

In this article, we explore the potential of grief counseling and therapy to manage that journey and offer some tools and techniques to help.

Before you continue reading, we thought you might like to download our three Grief Exercises [PDF] for free. These science-based tools will help you move yourself or others through grief in a compassionate way.

What Is Grief Counseling? A Definition of the Basics

Most people can deal with the grief they experience after a significant loss. For some, the experience of distress is so extreme or prolonged that they seek the help of a professional grief counselor (Worden, 2010).

An early, high level of distress “is one of the best predictors of later distress; it can show that the person is at risk for a poor bereavement outcome” (Worden, 2010, p. 83).

While grieving can seem natural, in earlier times, much of it was supported and facilitated through religious organizations, families, rituals, and customs. More recently, with changes in many of these areas, more people struggle to process intense loss and turn to counseling (Worden, 2010).

The goals of grief counseling

While grief can be associated with many forms of loss (including following a separation or divorce), here we focus on the processing related to bereavement. However, many of the concepts can be extrapolated to other aspects of living (American Psychological Association, 2022).

“The overall goal of grief counseling is to help the survivor adapt to the loss of a loved one and be able to adjust to a new reality without him or her” (Worden, 2010, p. 84).

It is helpful to highlight what psychologists and counselors call the “four tasks of mourning.” They facilitate adaptation to loss, involving confronting what has happened and restructuring thoughts, and include (Worden, 2010):

• Accepting the reality of loss
• Processing the pain of grief
• Adjusting to a world without the deceased
• Finding an enduring connection with the deceased while embarking on a new life

The following subgoals of grief counseling are therefore aligned with each task (Worden, 2010):

1. Increasing the reality of loss
2. Helping the individual deal with emotional and behavioral pain
3. Supporting them as they overcome obstacles to readjustment
4. Helping them find a way to maintain a bond while feeling comfortable reinvesting in life

Grief Counseling and Grief Therapy: What’s the Difference?

While grief counseling and grief therapy may appear similar, Worden (2010) offers a helpful distinction.

“Counseling involves helping people facilitate uncomplicated, or normal, grief to a healthy adaptation to the tasks of mourning within a reasonable time frame” (Worden, 2010, p. 83).

On the other hand, grief therapy involves more specialized techniques associated with treating “people with abnormal or complicated grief reactions” (Worden, 2010, p. 83).

Grief support through therapy is often most appropriate when the reaction to grief is (Worden, 2010):

• Complicated and prolonged
• Complicated and delayed
• Exaggerated

Complicated grief (or chronic grief) often involves the individual not accepting what has happened. They are left with long-term, intense sadness, anxiety, anger, guilt, and other emotions, interfering with their ability to reorient toward a new life (Brown, 2021).

Understanding Grief, Mourning, and Bereavement

The terms grief, mourning, and bereavement are typically used interchangeably in everyday conversation and yet are sometimes distinguished as follows by mental health professionals (Worden, 2010, p. 17):

• Grief – the experience of losing someone to death (it can also include other losses)
• Mourning – the process the bereaved passes through to adapt and become accustomed to the death or loss
• Bereavement – the loss the individual feels while they learn to adapt to the new situation

Bereavement Therapy for Adults

Most bereaved adults “tend to experience strong emotions, a sense of cognitive disequilibrium, and impaired role functioning for at least a short period” (Currier et al., 2008, p. 648).

Ten percent (10%) will experience intense suffering for a prolonged period — sometimes years (Currier et al., 2008). That loss can sometimes feel unbearable and even lead to several psychological and physiological debilitating symptoms.

The griever’s distress is not always reducible to common disorders such as anxiety, stress, and depression. As a result, standard therapeutic interventions may not work; hence the need for specific bereavement therapy and related interventions (Currier et al., 2008).

Bereavement therapy has been shown to help bereaved adults in distress, though statistical improvements have been small in some studies. Treatment should be specific to the individual to offer maximum benefits rather than provided as routine interventions (Currier et al., 2008).

Crucially, findings from a 2008 study suggest that bereavement interventions speed up the adjustment process, with individuals ultimately regaining pre-loss levels of functionality (Currier et al., 2008).

For further information, check out the article How to Do Bereavement Counseling: Resources & Interventions.

How to Provide Grief Counseling in Hospice Care

Whether grief counseling is performed by a dedicated therapist, social worker, or health care worker, the techniques and skills are valuable for supporting a family facing the loss of a loved one in a hospice (Davies, 2013).

Grief therapy can be profoundly helpful when there may no longer be a curative treatment for a serious condition. “Hospice care provides compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible” (American Cancer Society, 2019, para. 1).

Hospice nurses or social workers will often be involved in informing family members about the patient’s condition and what to expect through regular meetings. Family and loved ones can air their feelings and concerns, talk about what is needed, and learn about the process of dying in a safe and supportive environment (American Cancer Society, 2019).

After the loss, “a trained volunteer, clergy member, or professional counselor provides support to survivors through visits, phone calls, and/or other contact, as well as through support groups” (American Cancer Society, 2019, para. 15).

Ultimately, how grief counseling is offered, along with the timing and environment, is most vital to those facing the loss of loved ones.

Grief Therapy Techniques and Timing

Grief therapy must always be positioned to meet the needs of the bereaved.

Loss is individual, specific, and not always experienced in the same way for everyone (Neimeyer, 2015).

Grief therapy timing

“In most instances, grief counseling begins, at the earliest, a week or so following the funeral” (Worden, 2010, p. 85).

Whether death is expected or the result of trauma, putting loved ones in a state of extreme shock, the first 24 hours are a whirlwind of emotions. That initial time also includes meeting and communicating with family and friends about what has happened and beginning to think about the funeral arrangements. The individual may not fully accept or feel ready to come to terms with the unfolding events and find themselves caught up in intense grief and confusion (Worden, 2010).

When death is expected, family members may contact a therapist before the loss. However, on many occasions, it is an afterthought and the result of an inability to cope.

Assessment

“Bereaved individuals seeking professional help with their grieving want answers to questions about recovery, and ultimately they want to know how to make meaning out of the meaninglessness of their lives” (Neimeyer, 2015, p. 39).

The Hogan Grief Reaction Checklist (Hogan & Schmidt, 2016) was developed for research purposes and offers a helpful tool for assessing an individual’s current state of grief and whether they are regaining a sense of hope for the future.

The checklist considers various situations, from losing a loved one to grieving for an aging parent who has passed or the heartbreak of a lost child (Neimeyer, 2015).

The individual scores items on a scale between “Does not describe me at all” and “Describes me very well.” For example:

I have little control over my sadness.
I agonize over their death.
I worry excessively.
I have panic attacks over nothing.
I have learned to cope better with life.
I am resentful.
I feel detached from others.

5 Powerful techniques for grief counseling

While therapy must be grounded on a solid understanding of the individual and their personal and behavioral needs, the following techniques have proven helpful to many clients facing bereavement (Worden, 2010):

• Evocative language
  Direct language (such as, “Your wife died” or “You lost your wife”) can seem harsh, but it helps individuals face the reality of what has happened.
• Symbols and reminders
  Bringing in photos, letters, jewelry, awards, and memorabilia can open up discussions, even with the potential of introducing humor regarding anecdotes, habits, or things the person used to say or do.
• Drawing
  Creating pictures and artwork can facilitate feelings, increasing awareness of the loss and identifying where the individual is in their mourning.
• Cognitive restructuring
  How we think influences how we feel. When someone is stuck emotionally, the therapist can help by reality-checking their thoughts for accuracy and overgeneralization.
• Metaphors
  Using metaphors in grief counseling is a surprisingly powerful approach “for lowering resistance to the pain of bereavement when patients cannot directly confront feelings surrounding the death” (Worden, 2010, p. 107).

Online techniques and opportunities for grieving

Creating memory books can be helpful for actively remembering the deceased. Putting together photos, favorite music, and preferred locations encourages the family to reminisce and revisit memories of happier times (Worden, 2010).

Online memorials have become popular in recent years to collect images, sounds, and videos to remember the deceased. During the COVID-19 pandemic, when bereaved individuals were often unable to meet up or attend funerals because of social distancing, memorial websites provided an opportunity for loved ones to express their grief by sharing stories of those lost (Myers & Donley, 2022).

Online memorials help maintain a connection with the deceased that traditional memorials may not (Myers & Donley, 2022).

Furthermore, like other forms of digital therapy, online grief counseling provides vital support to many who are bereaved (Robinson & Pond, 2019).

4 Grief Counseling Interventions

There are many interventions available that therapists can tailor to the specific needs of grieving clients.

Role-play

Role-play can be an effective way for the bereaved to work through emotions and thoughts they find uncomfortable or fear sharing (Worden, 2010).

The therapist acts as either one of the players or a facilitator as the individual or group works through earlier situations or what they would like to have said to the deceased if they were still alive (Neimeyer, 2015).

Role-play may initially feel artificial, yet it can soon seem like the missing person is in the room, whether played by another family member, the therapist, or imagined in an empty chair. Things that never got said can be voiced, often with the speaker forgiving the deceased for their perceived wrongdoings or mistakes or simply for being absent (Neimeyer, 2015).

Our free worksheet If I Could Talk to You One Last Time … can help the client formulate what they want to say to the deceased before beginning the role-play.

Preparing for loss with positive thought processes

Many individuals experience anticipatory grief before death. “Notification of a diagnosed terminal illness in a loved one may be considered a shocking and traumatic event in itself and can represent a point where anticipatory grief begins” (Rogalla, 2020, p. 109).

Proactive coping can help manage stress in the early stages of grief. Those displaying affirmative emotions when discussing recent losses appear to adjust earlier and stronger after the initial grief has subsided (Rogalla, 2020). Social support seems to have the most significant impact as a mediator, and drawing individuals’ awareness toward growth is also beneficial.

My Grief Plan is a free resource to begin the planning process for coping with grief.

Grief and yoga

Meditation and yoga are powerful tools for managing and reducing the pain associated with bereavement.

Meditation has been shown to reduce many of the unwanted physical and psychological effects associated with grief, such as insomnia, poor memory and concentration, and the experience of difficult emotions, along with supporting overall good health (Black & Slavich, 2016; Desbordes et al., 2012).

For more information, check out our article on Grief Meditation and Yoga: Healing Through Awareness.

Our free Yogic Breathing script can prepare the body and mind for self-compassionate reflection.

Letter to the deceased

Unprocessed trauma can harm and impede the mourning process. Clients are encouraged to write a letter to the deceased to recognize their loss (Neimeyer, 2015).

When doing so, the writer should show themselves compassion, freeing themselves to be honest and open and writing what they truly feel. They may want to describe how they will miss the person, what the relationship means to them, or their anger for being left behind. While the letter is addressed to the deceased, it is truly written for the living (Neimeyer, 2015).

Writing the letter “can help survivors take care of unfinished business by expressing the things that they need to say to the deceased” (Worden, 2010, p. 105). The intervention can lead to fewer negative feelings and a sense of resolution.

Use our Letter to a Loved One template to take the opportunity to write down what has been left unsaid.

For more information, check out the resources in our article 9 Grief Books, Worksheets, & Journal Prompts to Help Clients.

More PositivePsychology.com Resources

We have many resources available for therapists providing support to those experiencing grief.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below.

• Reconnecting With the Deceased Through Imagery
  Humans are hardwired for visual imagery, and it plays a significant role in supporting our core cognitive processes.

This exercise helps bereaved clients rekindle attachment bonds and reconnect with deceased loved ones through guided imagery.

Try out the following steps:

• • Step one: Reconnect through imagery.
    Imagine meeting your deceased loved one face to face.
    Tell them whatever you want and talk about what you miss.
    When you’re ready, say goodbye to your loved one and watch them walk away.
  • Step two: Reflect.
    Take some time to reflect on the imagery, asking yourself the following questions:
    – How did it feel to reconnect with your loved one through imagery?
    – Why is this so meaningful to you?
    – What is the most valuable insight you gained from this exercise?
    – What changes do you notice in your feelings after completing this exercise?
• Working Through the Four Tasks of Mourning
  In this task, we explore Worden’s (2010) four tasks of mourning model, identify the client’s current state, and suggest ways to move forward.
  • Task 1: Accept the reality of loss.
    Work toward acknowledging that the loss is real. Consider talking and writing about
    the emotional pain and how it feels to miss the person.
  • Task 2: Experience the pain of loss.
    Aim to experience the pain of loss fully. Lean into the experience.
    Ask yourself:
    – What feelings are coming up for you in your grief?
    – Is there anything holding you back from allowing your feelings to be present? If so, what?
  • Task 3: Adjust to the new environment without that person.
    This task’s significant feature is coping with the loss through problem-solving.
    Answer the following questions to get started:
    – How has your role changed? What new tasks are yours?
    – How has your view of the world been affected?
  • Task 4: Reinvest in the new reality while remembering the deceased.
    The primary goal of this task is to find a way to memorialize the deceased in a way that will not stop you from going on with your life.
    Ask yourself:
    – How can you keep your loved one with you and still go on?
    – What do you want for yourself now?

Having answered all the questions, pause and reflect on your answers. Think about what task you are in and how you can move forward to the next one.

A Take-Home Message

“Losing a loved one to death is an inherent part of human life” (Currier et al., 2008, p. 648). Knowing that reality, though, does not make the process easier.

In some cases, the impact of loss can have long-lasting psychological and physiological consequences that can be difficult to return from.

While distinct in their focus, grief counseling and grief therapy seek to guide clients through their bereavement, ultimately aiming to help them rediscover meaning in life while maintaining a connection to their lost loved one.

The key to success in either approach is tailoring the techniques, timing, and setting to the individual’s unique needs. There is no one-size-fits-all solution for navigating the complexities of grief. Instead, the therapist should adapt tools and interventions to suit the client’s specific circumstances.

This article explored various therapeutic interventions, such as imagery, role-play, active coping strategies, meditation, and yoga. Combined with the compassionate support of a grief counselor or therapist, all of these can prove beneficial in supporting a grieving client.

We hope you benefited from reading this article. Don’t forget to download our three Grief Exercises [PDF] for free.

Ed: Updated April 2023